Report Evaluates Knowledge of How to Retain Older Nurses in Bedside Practice

Evidence of retention strategies' effectiveness is scant; findings among first to seek nurses' own views of working to retirement

    • June 14, 2006

Variables such as flexible work hours, increased benefits, newly created professional roles, better designed hospital equipment and buildings, and an atmosphere of respect for nurses are central considerations for hospitals seeking to recruit and retain older nurses, according to a new paper issued today.

The report, “Wisdom at Work: The Importance of the Older and Experienced Nurse in the Workplace,” supported by the Robert Wood Johnson Foundation, notes that retaining older nurses is one important strategy for stemming the national nursing shortage.

“There's a lot of attention to the need to recruit new nurses into the profession, and that is an important issue,” said Susan B. Hassmiller, R.N., Ph.D., F.A.A.N., senior program officer at the Robert Wood Johnson Foundation. “But we also need to take advantage of the knowledge and wisdom that experienced nurses build up over their years in practice, and to make changes that encourage more of those nurses to stay in their jobs.”

The study brings new insights to the question of retaining an aging nurse workforce; the average age of a nurse today is nearly 47 years. Retaining experienced nurses is especially critical given the high cost of nurse turnover, as well as increasing health care needs as baby boomers age.

Little research has been done to test which recruitment and retention strategies are effective with older nurses, but identified the study authors' review of the existing literature identifies four key themes that contribute to older nurses' decisions about continuing to work:

  • Health status
  • Financial status
  • Attitude toward retirement
  • Current job satisfaction

The study was one of the few ever to ask older nurses what would keep them working until retirement. In addition to conducting the literature review, study authors surveyed 377 nurses and held in-depth interviews with 13 experienced experts in health care systems design, executive leadership and management, patient-centered care, patient safety, and labor relations.

“The seasoned nurses we interviewed believe we must very quickly transform the work environment so that older nurses are welcomed, accommodated, appreciated and used wisely,” said lead study author Barbara J. Hatcher, Ph.D., R.N., M.P.H., director of the Center for Learning and Global Public Health at the American Public Health Association.

Among the changes cited to make nursing attractive to and supportive of older nurses:

Revised employment policies: Specifically, nurses called for greater flexibility in scheduling and innovative new nursing positions such as mentor, research assistant or safety officer. They also voiced interest in better employee-employer relationships and in smoother transitions into management.

Better ergonomics and health care design: To decrease the time nurses spend walking on the job and the physical demands of their work, nurses suggested mechanical patient lifts, decentralized storage of supplies, and better lighting at the bedside.

Improved introduction and use of technology: Nurses called for adequate training in the use of technology as well as input of experienced nurses in the choice of technology purchases. This input would help hospitals by outfitting equipment with, for instance, large enough fonts to be seen easily by older nurses, respondents said.

Changes in organizational culture: Nurses seek greater autonomy and participation in decision making. “Nurses are tired of doing a difficult job under stressful conditions and of not having their contributions acknowledged,” the report states.

Commitment to training and education: Older nurses said ongoing learning is especially critical to retaining senior nurses promoted to managerial or innovative positions that require new skills.

The study's authors also urge hospitals to learn more about “nurses' intent to leave their organization and the potential gaps created by retiring older nurses.” The report also warns of the high costs in terms of patient outcomes and safety when hospitals lose the knowledge of seasoned professionals.

The full report is available on the Robert Wood Johnson Foundation Web site at http://www.rwjf.org/files/publications/other/wisdomatwork.pdf

Authors of the Wisdom at Work study are:

  • Barbara Hatcher (editor), American Public Health Association
  • Michael R. Bleich, University of Kansas
  • Charlene Connolly, Northern Virginia Community College
  • Kathleen Davis, Presbyterian Health System, New Mexico
  • Peggy O'Neill Hewlett, University of South Carolina College of Nursing at Columbia
  • Karen Stokley Hill, Central Baptist Hospital, Lexington, Kentucky

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About the Robert Wood Johnson Foundation

The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation's largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. For more than 30 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime.

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